Serial Changes of Transmitral Inflow Patterns after Acute Myocardial Infarction

BACKGROUND: Although determination of Doppler echocardiographic transmitral inflow patterns(DETIP) is used as an indrect method assessing LV diastolic function. It is known that DETIP can be affected by certain hemodynamic variables. The aim of this investigation is to assess the serial changes of DETIP and to determine the relation of DETIP with clinical parameter such as initial left ventricular end-diastolic volume(LVEDV), ejection fraction(EF), Killip class and thrombolytic therapy in acute myocardial infarction (AMI) patients. METHOD: Four serial Doppler and 2-D echocardiographic studies were performed at 1 day, 1 week, 1mouth, and 3 months after development of AMI in 24 patients(M:F=19:5, aged 58+/-11 year , 15 anterior MI) and 13 normal adults (aged 47+/-9 years) as reference group. On admission 14 patients were in Killip class I and 10 patients in class II. Thrombolytic therapy with IV urokinase were done in 11 patients. E velocity, pressure half-time (PHT), and isovolumic relaxation time(IVRT) were analyzed and LV systolic function was determined in apical 4 chamber view. RESULTS: DETIP did not change until 1month after development of AMI. However, E/A ratio was decreased, and PHT and IVRT were increased at 3 months after AMI. Doppler transmitral flow parameters were not related with Killip class and LV systolic function. Patiens who recieved urokinase intravenously and who had greater intial LVEDV(>118cm3) showed higher E/A ratio and shorter PHTand IVRT than those who did not. These findings indicate that changes in Doppler transmitral inflow pattern in AMI patients are not uniform over a period of 3 months and thrombolytic therapy causes favorable effect on Doppler transmitral flow parameters. CONCLUSION: Changes in Doppler trasmitral inflow pattern may be variable over post-AMI period and this should be taken into account in evaluating LV diastolic function after AMI. Thrombolytic therapy may improve LV diastolic function in AMI patients.

The Pattern of Pulmonary Venous Flow in Various Heart Disease

To evaluate the influencing factors on pulmonary venous flow(PVF) pattern, we studied the relationship between PVF and left ventricular ejection fracton(EF), mitral annulus motion(MAM) and transmitral flow using pulsed doppler echocardiography in patients with dilated cardiomyopathy(DCMP), acute myocardioal infarction(AMI), left ventricular hypertrophy(LVH) and atrial fibrillation(AE). Ther results were as follows : 1) In the normal controls(13 cases), two forward flow during ventricular systole(VS) and diastole(VD) and one retrograde flow during atrial systole(AS) were observed. The peak velocity of VS, VD and AS flow was 45.9cm/s, 42.8cm/s and -18.3cm/sec, respectively. The peak VS/VD ratio was 1.1. 2) In patients with DCMP(11 cases), (a) compared to the noraml subjects, the peak velocity of VS flow and VS/VD ratio were were significantly reduced(p<0.005 and p<0.001, respectively) and were positively correlated with ejection fraction(r=0.8 and r=0.7, respectively) (b) in 2 DCMP cases with severe mitral regurgitation, systolic retrograde flow was observed in the pulmonary vein instead of forward VS flow. 3) In 12 AMI cases and 7 LVH cases with normal or slightly diminished left ventricular systolic function but with abnormal diastolic function. (a) the peak velocity of VS flow and peak VS/VD ratio were significantly increased(r<0.005 and p<0.01, respectively). (b) the peak velocity of VD flow is positively correlated with transmitral E/A ratio(r=0.8) and the peak VS/VD ratio was positively correlated with transmitral pressure half time(r=0.8). (c) the peak velocity of retrograde AS flow was significantly increased(p<0.001). (d) there was no correlation between doppler parameters of PVF and left ventricular ejection fraction. 4) In patients with atrial fibrillation(10 cases), VS flow was markedly diminished or absent and only VD flow was observed. Also, retrograde AS flow was not observed. These findings suggest that the pattern of PVF is influnced by LVEF, MAM, transmitral inflow and atrial contraction. However, main contributary factors in determining the pattern of PVF in each disease are diverse according to its main pathophysiology.